Background

Low bone mineral density (BMD) is common in patients with inflammatory bowel disease and is a leading cause of morbidity in such patients. Data about bone disease in male with ulcerative colitis (UC) is scarce. Our aim was to assess the prevalence of low BMD among male UC patients on a nationwide level.

Methods

Nationwide data was obtained from the Veterans Affairs (VA) healthcare system. Male veterans seen by the VA between 2001 and 2011 were identified using ICD-9 and were included in our analysis. Automated data extraction captured information about the veterans' demographics, presence of bone disease and the other risk factors for low BMD [corticosteroid (CS) use, hyperparathyroidism, hypogonadism, malnutrition, vitamin D deficiency and smoking]. The rate of bone disease by cumulative CS decile was calculated. Multivariate logistic regression analysis was used to identify the independent effect of each factor on bone disease.

Results

We included 34,665 male UC patients (mean age 66, Caucasians 75%). Prevalence of osteoporosis among the included population was 6.5%, while for osteopenia it was 4.3%. Those who used CS (30% of the included population with mean duration of nine months) had higher prevalence of bone diseases (10.2% and 7%) compared to those who did not use CS (4.8% and 3.2%) for osteoporosis and osteopenia respectively, p < 0.001. By using multivariate analysis, we found that cumulative oral CS deciles was the most significant independent predictor of bone disease and showed a significant trend (dose-response) pattern even in those with lowest decile of cumulative CS exposure.

Conclusion

In this large nationwide male UC cohort, 41% of those in the highest CS use decile had osteoporosis or osteopenia. CS use is the most important independent risk factor for low bone density among UC male patients. Efforts should be taken to reduce CS utilization among these patients by using other immunosuppressant agents.